Some links and readings posted by Gary B. Rollman, Emeritus Professor of Psychology, University of Western Ontario

Monday, September 17, 2012

With MRI delays the worst in the province, eastern Ontario tries to clear its backlog - Ottawa Citizen

Eastern Ontarians, particularly the walking wounded, are waiting longer for MRIs than they did three years ago even though the region has acquired three new machines to do more scans.

The most recent provincial data show the region continues to have Ontario's longest delays.

From the time a magnetic resonance imaging scan is ordered to the time it is scheduled, nine out of 10 eastern Ontarians now wait as long as 209 days, more than twice the provincial average of 84.

In 2009, when the Ontario government started publishing medical wait times, patients in this region were waiting up to 136 days.

The wait to get a diagnostic scan is often the tightest bottleneck a sick or injured person has to pass through to receive treatment.

Officials are quick to point out that the patients who are waiting the longest are not those with life-threatening conditions such as cancer, heart disease or brain disorders. Rather, they are patients with back pain or muscle injuries.

"What we're talking about here are people who don't have conditions that need to be scanned urgently," says Chantale LeClerc, chief executive of the Champlain Local Health Integration Network, eastern Ontario's health authority. "And unfortunately, people who have more urgent situations continually get seen before them. So they keep waiting longer and longer."

By far the longest delay is at The Ottawa Hospital, which has seen its waits climb to 271 days from 188. The Children's Hospital of Eastern Ontario, which also does MRIs for adults, has seen its wait time creep up to 70 days from 63.

Only two hospitals have shown improvement. From 155 days three years ago, the wait at the Queensway Carleton Hospital is now 113 days, while the Montfort Hospital has shortened its wait to 66 days from 90 since 2009.

Over the same period, the regional wait time for computerized tomography scans has been cut in half, to 48 days from 97. Nonetheless, eastern Ontario still ranks last among 14 provincial health regions for CT scans.

Officials point to unequal caseloads among hospitals as the root cause of the MRI problem. The sharpest imbalance is at The Ottawa Hospital, which performed nearly 33,000 scans last year.

Even with three MRI scanners running virtually around the clock seven days a week, the waiting list continues to grow. "Every month, we get 10 per cent more requisitions than we can possibly do," says Dr. Mark Schweitzer, head of diagnostic imaging.

Schweitzer says managing the seemingly endless demand for MRIs has become a delicate balancing act, especially with the rise of cancer and other chronic diseases that require patients to have regular imaging followup.

Even with the addition over the past four years of three new MRI scanners (one at The Ottawa Hospital, a second at Montfort and a third at the Queensway Carleton, bringing the regional total to 10), eastern Ontario still can't keep up with demand, says Schweitzer. "We're colossally under-resourced."

The pressures are disproportionately on The Ottawa Hospital because, as the region's only advanced-care centre, it is the sole provider of diagnostic services to patients with cancer, heart disease and brain disorders. That makes it difficult for them to go to other hospitals, which do not have the expertise to do those types of MRIs, says Schweitzer.

As a result, the hospital's lower-needs patients, who could get their MRIs elsewhere, are forced to wait longer than they have to.

To take some of the pressure off, officials are looking to redirect at least 1,500 of the hospital's least urgent cases to facilities with shorter waiting lists. If successful, the move would clear the backlog of patients who have waited longer than 200 days.

LeClerc said patients and their physicians will be urged to switch voluntarily to other hospitals. "People will still have a choice, but those who want to be redirected somewhere else will get the option."

She indicated that no additional funding would be allocated to the facilities that accept some of The Ottawa Hospital's patients.

At least one hospital says it is ready to do its part, even if its MRI wait time get longer as a result.

"At the end of the day, those numbers are patients," says Tom Holland, director of clinical services at Montfort, which handled 20,000 MRIs last year. "They're people and they're waiting. There should be no reason why a patient should wait 280 days at The Ottawa Hospital, but 100 days at Montfort."

The Queensway Carleton, which installed its second MRI machine in May, is also preparing to do more scans. However, the hospital says its ability to pick up some of the load could be limited if it doesn't get enough provincial funding to pay for longer operating hours.

"We can certainly do a lot more MRIs, but the funding is always a challenge," says Carolyn Brennan, the Queensway Carleton's chief financial officer.

Officials are hoping that the addition of two more MRI scanners next year will continue to help drive down wait times. The Cornwall Community Hospital is expected to have its machine up and running by next spring, with the Pembroke Regional Hospital following suit after that.

In the long run, what's needed is a centralized booking and triage system, which eliminates the traditional practice of having family doctors refer patients to a specific hospital for diagnostic scans, officials say.

The system would cut wait times by removing the prerogative of family physicians to refer patients to the hospital of their choice and eliminate the wildly uneven queues at individual hospitals.

While such a system has been talked about for the past four years, it has had difficulty attracting provincial funding.